Thursday, May 3, 2012

Health warnings on cigarette packs signal moral progress, not 'nannying'

May 2, 2012

DR ANDY Ho's commentary ('Lessons on smoking from the nanny state'; last Saturday) claims that health warnings on cigarette packs are paternalistic in the sense of 'nudging' individuals to stop smoking, and are founded on an undesirable premise that people are not assumed to behave rationally.

[Such a poor summary of Dr Ho's article!]

But as much as Dr Ho believes that such health warnings manipulate the emotions of individuals whose independence is already impaired through addiction to tobacco, Occam's razor suggests a simpler justification, namely, the individual's right to make an informed decision.

The salutary effect of gory health warnings on cigarette packs should not be overstated, given that only time will tell whether they have been truly effective, and the danger that individuals may become desensitised through repeated exposure to these warnings.

Equally, if not more, powerful emotional forces are triggered by peer pressure and addiction, which drive an individual to buy cigarettes.

The health warnings serve as a last stand, offering information on the long-term effects of smoking for the individual to make a fully informed decision.

It is a fact that smoking increases one's risk of contracting diseases and cancers - concealing this hampers not so much 'the public's long-term interests', but rather the individual's ability to weigh the long-term consequences of smoking.

That more and more Western nations are passing laws to include health warnings on cigarette packs is not a sign of pouring the old wine of 'nannying' into the new wineskins of 'libertarian paternalism'.

On the contrary, it signals moral progress as the world is increasingly recognising the need for individuals to make rational decisions about their health, and that this can be achieved only through a proper regulatory framework. Ethical progress in what some say is a post-modern world should be lauded, and not criticised.

Alvin Chen

[A pious, self-important graphophile with poor reading-comprehension skills setting up a straw man argument just to showcase his half-baked, recently acquired vocabulary like "Occam's razor". Probably has delusions of becoming the next opposition MP.]

Apr 28, 2012

Lessons on smoking from the nanny state

By Andy Ho

IT IS mandatory for all cigarettes sold here to have grisly warning images as well as textual health warnings on the box.

In place since July 2004, the current policy requires health warnings to cover 50 per cent of the front and 50 per cent of the back of all boxes.

As many points of sale display whole cartons as well, from next March these health warnings will have to appear on carton packaging as well.

Such a regulatory approach to correcting risky lifestyles may have been criticised by the liberal West as nannying. But it is now being adopted widely in many Western democracies, dressed up in new clothes called 'nudging' instead.

The term comes from the 2008 bestseller Nudge: Improving Decisions About Health, Wealth, and Happiness, a popular book by University of Chicago economist Richard Thaler and Harvard law professor Cass Sunstein.

The authors recount what cognitive neuroscience, social psychology and behavioural economics can teach regulators in trying to get people to behave better. The approach, typified by tobacco control policies, is 'permit but discourage'.

Though targeted at lay people, the book's agenda was huge - to move liberal democracies down the paternalistic path. The authors call theirs a 'libertarian paternalism' - libertarian in that people remain free to do what they like, but paternalistic in trying 'to influence people's behaviour... to make their lives longer, healthier and better'.

The idea is to structure the environment in such a way that people are subtly influenced or 'nudged' towards making certain decisions that policymakers have decided are 'better' for them and for society. This may be done by making the preferred choice cognitively easier to perceive. All this can be achieved without imposing a particular outcome on anyone, so nobody's individual liberty is infringed upon.

With the election of President Barack Obama, 'nudging' moved from book page to policy dossier. In January 2009, President Obama appointed Professor Sunstein as the Administrator of the White House Office of Information and Regulatory Affairs. The Office of Management and Budget was then ordered to 'clarify the role of the behavioural sciences in formulating regulatory policy'.

The US will now adopt warning images on cigarette packaging from this September. These are much tamer than those seen here, but are in stark contrast to the current US practice of including only bland textual health warnings on the box.

In May 2010, when Britain's Conservative-led coalition government walked into 10 Downing Street, it consulted with Professor Thaler, after which a seven-person 'Behavioural Insight Team' was put together in the Prime Minister's Cabinet Office to look at behavioural research and help to craft policies that nudge individuals into making better lifestyle choices.

Britain has had text-only warnings on 30 per cent of the front and 40 per cent of the back of cigarette packs since 2002. Last week, it began consultation over plain unbranded packaging for cigarettes, with just a health warning on them.

Also last week, a global test case began in Australia's highest court, where the world's Big Four tobacco firms went to block a new law as unconstitutional.

From December, that law requires all cigarette packs to come in olive green only, with stark photos and text health warnings. No brand logos are allowed. Only company names in a small, standardised font will be permitted. A decision before December is likely.

Last week, New Zealand announced that it was also introducing similar unbranded cigarette packaging, modelled on the Australian statute.

In the old days, the discipline of regulation assumed that people were rational, so policies were designed around the idea that people would rationally avoid risky behaviour that came with punishment, such as more expensive smokes.

In this 'New Governance' - new for the West but really old hat in pragmatic Singapore - people are not assumed to behave rationally. Instead, they are thought to be conditioned by cues in their environment, especially when their self-autonomy is impaired by addictive substances.

Those addicted to tobacco or heroin, say, are neither fully lacking in autonomy nor completely unimpaired in their autonomy. Instead, their autonomy is impaired without being completely nullified.

By engaging their emotions, using gruesome cues to dramatise risk, for instance, such autonomy-impaired individuals can be nudged into seeing more clearly whether continuing to smoke is worthwhile.

The aim is not to make smokers weigh their options rationally. Thus, the idea is not to dissuade certain behaviours using media campaigns to disseminate information - 'Smoking Kills', for instance.

Instead, the context in which all smoking choices are made is altered with gory imagery of its harrowing consequences.

This paternalism clearly manipulates the emotions, even if it were deployed in the public's long-term interests. Yet, it seems increasingly accepted in Western democracies, at least for lifestyle risks, especially with an autonomy-impairing product like tobacco.

The nanny state might be tempted to say 'I told you so', but could more charitably just note that the Emperor has borrowed clothes, which do seem to fit.

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